CHAPTER ONE

1.0. INTRODUCTION AND STATEMENT OF PROBLEM

Diabetes mellitus (DM) represents a chronic metabolic disease characterized by hyperglycemia due to a total or relative lack of insulin secretion and insulin resistance or both (Al – Maskari, 2011) patients with high blood sugar will experience frequent urination (polyuria), increased thirst  (polydipsia) and excess hunger (polyphagia).

Being an important public health problem, diabetes is one of the four priority non-communicable diseases (NCDs) targeted for action by the World Health Organization (WHO, 2014). According to the international diabetes federation (IDF, 2017) estimates, 424.9 million people are living with diabetes worldwide and by 2045, the number will reach 628.6 million. This is of great concern in Sub-Saharan Africa due to the low socio-economic status of the population (Mbanya, 2010). The World Health Organization (WHO) defines oral health as “ a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal(gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking and psychosocial wellbeing (Saini, 2010).

Diabetes has been clearly confirmed as a major risk factor for periodontitis. The risk of periodontitis is increased by approximately threefold in diabetic individuals compared with non-diabetic individuals. The level of glycemic control is of key importance in determining increase risk. The two diseases have a bidirectional adverse relationship to each other (Preshaw, 2012). Diabetes can aggravate periodontitis, and periodontitis can negatively affect the glycemic control of diabetics. Oral hygiene awareness and treatment of periodontal diseases play an important part not only in prevention of many complications due to diabetes but also decrease the morbidity due to these manifestations.

A recent study carried out on the evaluation of oral health knowledge and attitudes among diabetics in India showed that diabetics have poor knowledge about diabetes and oral health (Gupta, 2018). Yuen et al demonstrated in 2009 in a cross sectional study carried out in the US on diabetic patients that more than half of diabetic patients had limited knowledge about oral health and their condition (Yuen et al, 2009). In a similar study carried out in Jordanians with diabetes revealed that knowledge about diabetes and periodontal health among diabetic patients is low, and majority of patients were unaware of the oral health complications of their disease and the need for proper preventive care (Habashneh et al 2010) Talwo Jo in Nigeria showed that majority of diabetic patients do not know that factors in diabetics can contribute to oral ill health and most importantly quite a number of diabetics were not aware of the need for glycemic control to prevent oral health infections (Talwo, 2000).

Diabetes mellitus is often associated with many oral complications such as periodontitis, salivary dysfunction, burning mouth syndrome, oral candidiasis and more, most of these being as a result of infections. It is therefore important to prevent these oral manifestations in these patients as their immune system is already suppressed. Moreover, these oral infections can interfere with control of diabetes and irreversible sequelae. To promote proper oral heath behavior that limit the oral complications, education of diabetic patients is very important. Before education, it is necessary to assess the diabetic patient’s oral health behavior (Bahamman, 2015).

During the investigator’s clinical experience at the RHAB, she came across a fifty-five year old diabetic patient who was diagnosed with oral candidiasis (a disease caused by an over growth of the fungus candida albicans) as a result of poor oral hygiene. The condition was not properly handled by the patient and further complicated to invasive candidiasis. As a result, the patient got into a state of depression and died a few weeks after due to his low socio-economic status.

The investigator also witnessed a thirty-five years old diabetic patient who was diagnosed with periodontitis “Gum Disease” caused by poor oral hygiene. As a result of limited knowledge, the condition progressed to loose teeth and loss of teeth. After realizing from the cases above and many others not mentioned how important oral health is to everyone especially to diabetic patients, the investigator decided to find out with the following:

1.1. RESEARCH QUESTION

What Knowledge do diabetics have on the relationship between oral health, attitudes and oral status?

1.2. Research Objectives,

1.2.1. General objective;

To ASSESSING ORAL HEALTH KNOWLEDGE, ATTITUDES AND ORAL STATUS IN PEOPLE LIVING WITH DIABETES ATTENDING REGIONAL HOSPITAL BUEA

1.2.2. Specific Objectives

– To assess the oral health knowledge and attitudes in people living with diabetes.

– To determine oral status in people living with diabetes